The transvenous pressure cooker technique: A treatment for brain arteriovenous malformations

Guang Zhang, Shiyi Zhu, Pei Wu, Shancai Xu, Huaizhang Shi, Guang Zhang, Shiyi Zhu, Pei Wu, Shancai Xu, Huaizhang Shi

Abstract

The treatment of brain arteriovenous malformations (AVMs) remains a significant challenge, especially hemorrhagic AVMs which are unsuitable for microsurgery or radiosurgery. We demonstrate an AVM located in the left basal ganglia area, supplied by slender arteries, and treated by the transvenous pressure cooker technique. Herein, we describe the procedure and outline the crucial points and indications for this technique.

Keywords: Brain arteriovenous malformation; pressure cooker technique; transvenous embolization.

Figures

Figure 1.
Figure 1.
(a) The first CT scan showed a cerebroventricular hemorrhage. (b) Diagnostic brain MRI revealed an AVM located in the left basal ganglia area. Gamma knife treatment was then recommended. (c) Four months later, the patient presented with a severe headache followed by unconsciousness and repeat CT revealed a cerebroventricular hemorrhage with acute hydrocephalus. She underwent immediate external ventricular drainage. (d) CT scan after external ventricular drainage.
Figure 2.
Figure 2.
DSA revealed an AVM fed by the lenticulostriate arteries and some branches arising from the left anterior cerebral artery. The AVM had a single drainage site and a small nidus measuring 2 cm in diameter.
Figure 3.
Figure 3.
Diagrammatic sketch of transvenous PCT.
Figure 4.
Figure 4.
(a) A microcatheter (Sonic, Balt, France) was placed as close as possible to the nidus. (b) Another microcatheter (Echelon-10, Ev3, Irvine, California, USA) was navigated alongside the Sonic into the draining vein. Its tip was positioned between the most distal marker and the detachment zone of the Sonic. (c) A balloon was placed from the anterior cerebral artery to the end of the carotid artery. (d) Then, coils were placed in the draining vein through the Echelon-10 microcatheter to create a plug.
Figure 5.
Figure 5.
Onyx was injected slowly, but at a higher rate than arterial injection.
Figure 6.
Figure 6.
After treatment, control DSA confirmed anatomic resolution of the lesion.

Source: PubMed

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